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Scientists have developed a spit test that could ‘turn the tide’ on prostate cancer worldwide by spotting the disease earlier, finding where men are at high risk and saving others unnecessary treatment.
The number of men diagnosed with prostate cancer worldwide is predicted to double 2.9 million per year by 2040, with annual deaths expected to increase by 85%. It is now the most common form of cancer in men in more than 100 countries.
Early diagnosis is crucial, but experts say current standard PSA blood tests can miss men who have cancer and also put others through unnecessary treatment or pointless extra tests and scans.
Now researchers from the Institute of Crab Research, London (ICR) and the Royal Marsden NHS Foundation Trust seem to have found a better alternative.
A study shows that their new saliva test, which involves taking a DNA sample in seconds, is more accurate than the current standard blood test. The findings are being presented this weekend at the world’s largest cancer conference.
“With this test, it may be possible to turn the tide of prostate cancer,” said Ross Eales, professor of oncogenetics at the ICR. “We have shown that a simple, inexpensive test to identify men at higher risk due to their genetic makeup is an effective tool for catching cancer early.”
Speaking at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago, Eeles said the breakthrough comes after decades of research into genetic markers of the disease.
“Our study shows that the theory works in practice – we can identify men at risk of aggressive cancer who need further testing and protect men who are at lower risk from unnecessary treatments.”
Scientists and doctors developed the spit test after examining the DNA of hundreds of thousands of men. It works by looking for genetic signals in saliva that are linked to prostate cancer.
In the Barcode 1 trial, researchers recruited more than 6,000 European men to try the spit test. All were recruited from their GP practices and were aged between 55 and 69 – an age at which the risk of prostate cancer is increased.
After the saliva is collected, the test calculates each man’s polygenic risk score (PRS). The result is based on 130 genetic variations in the DNA code that are associated with prostate cancer.
In those at the highest genetic risk, the test gives fewer false positives than the PSA test, detects people with cancer that would be missed by the PSA test alone, and detects a higher proportion of aggressive cancers than the PSA test. PSA, ICR said.
The test also accurately identified men with prostate cancer who were missed by MRI scans.
Dairesh Turnbull, 71, from Brighton, was one of the first men in the world to try the spit test and discovered he had prostate cancer when he got the results.
He said: “I was completely shocked when I got my diagnosis as I had absolutely no symptoms so I know I would never have been diagnosed at this stage if I hadn’t joined the process.”
Turnbull underwent robotic surgery to remove part of his prostate and is doing well.
He said: “As the saliva test revealed that I had a high genetic risk of developing the disease, my younger brother, who would have been too young to take part directly in the study, enrolled and discovered that he also had aggressive tumor in the prostate. It’s incredible to think that two lives in my family have been saved because of this study.”
Eales, a consultant in clinical oncology and cancer genetics at the Royal Marsden NHS Trust, warned that further research would be needed before the test could be rolled out widely.
“Our next step will be to test the genetic markers we identified that are associated with prostate cancer risk in different populations to ensure that this test can benefit all men.”
An aging population and increasing life expectancy mean that the number of older men around the world who are living longer is increasing. Because the main risk factors for prostate cancer – such as being 50 or older and having a family history of the disease – are unavoidable, experts believe it will be impossible to prevent cases from rising simply through lifestyle changes or public health interventions.
However, better testing and earlier diagnosis can help reduce the burden and save lives.
“Cancers that are detected early are much more likely to be curable,” said Prof. Christian Helin, ICR CEO. “And since prostate cancer cases will double by 2040, we need to have a program to diagnose the disease early.”
“We know that the current PSA test can put men through unnecessary treatments, and more worryingly, it’s missing men who have cancer.” We urgently need an improved disease screening test. This research is a promising step toward that goal and highlights the role that genetic testing can play in saving lives.
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